Key result
Single burr rotational atherectomy linked to ~64% lower MACE risk versus non-single burrs.
Why the study?
The association of procedural indices and baseline lipid parameters with prognosis after rotational atherectomy in patients with severe coronary calcification was unclear.
Does rotational atherectomy using a single burr reduce cumulative major adverse cardiac events in patients with severe coronary calcification compared to non-single burrs?
Cohort (n=287)
No
Does rotational atherectomy using a single burr reduce cumulative major adverse cardiac events in patients with severe coronary calcification compared to non-single burrs?
Hazard Ratio: 0.36 (95% CI 0.2–0.66)
p-value: p=0.001
In patients undergoing rotational atherectomy for severe coronary calcification, the use of a single burr is associated with better long-term outcomes compared to the use of multiple burrs, whereas baseline lipid parameters showed no significant association.
May aid risk stratification in RA-treated calcified lesions; leaves open whether modifying procedural indices or lipids improves outcomes.
The aim of our study is to evaluate the association of rotational atherectomy (RA) operation procedural indices and baseline lipid parameters with the prognosis of the patients with severe coronary calcification who underwent RA. Our study population consists of 287 patients treated with RA in Fuwai Hospital from January 2013 to December 2019. We analyzed the patients’ rotation procedural indices including the number of burrs, the size of burrs, approach site, the size of guiding catheter, along with the baseline level of lipoprotein(a) (Lp(a)), low-density lipoprotein-cholesterol (LDL-C) and high-sensitivity C-reactive protein (hs-CRP) to examine the association of these measurements with the prognosis of these patients using Cox regression analysis and Kaplan-Meier survival analysis. We find that during the follow-up period of 56.7 months with the median, the use of single burr in the patients who underwent RA was significantly associated with the occurrence of cumulative major adverse cardiac events (MACE) when compared with using non-single burrs [Hazard Ratio (HR) 0.43, 95% confidence interval (95% CI) 0.24–0.77, p = 0.004] from univariate Cox regression analysis; (HR 0.36, 95% CI 0.20–0.66, p = 0.001) from multivariate Cox regression analysis In addition, we find a higher event-free survival rate in the single-burr group after Kaplan-Meier survival analysis (Log rank p = 0.0033). However, there was no significant association of the size of burrs with the occurrence of MACE (HR 0.90, 95% CI 0.47–1.73, p = 0.76). Similarly, we find no significant associations between the approach site and the occurrence of MACE (HR 0.79, 95% CI 0.24–2.53, p = 0.69), the baseline Lp(a) (HR 1.07, 95% CI 0.76–1.49, p = 0.71), the level of LDL-C (HR 0.83, 95% CI 0.55–1.26, p = 0.38) or hs-CRP (HR 0.85, 95% CI 0.45–1.58, p = 0.60). We find that the patients who receive RA with a single burr have better outcomes than those who receive RA with non-single burrs. Moreover,we find that the number of burrs used in RA instead of the size of burrs, approach site, the size of guiding catheter, or baseline levels of Lp(a), LDL-C or hs-CRP had significant association with the prognosis of RA patients.
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Zhang et al. (2021) conducted a cohort in Severe coronary calcification (n=287). Single burr use during rotational atherectomy vs. Non-single burrs was evaluated on Cumulative major adverse cardiac events (MACE) (HR 0.36, 95% CI 0.20-0.66, p=0.001). The use of a single burr during rotational atherectomy was associated with a significantly lower risk of cumulative MACE compared to non-single burrs (HR 0.36; 95% CI 0.20-0.66; p=0.001).
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